Committed to the Land of a Thousand Hills

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This story began ten years ago when my office at the University of Western Ontario received a letter from Dr. Emile Rwamasirabo, then Rector of the National University of Rwanda. He explained that almost all doctors in Rwanda had either been killed or had fled the country during the genocide. Moreover, the few doctors still remaining in Rwanda, of necessity, were engaged in administration rather than patient care in hospitals and clinics.

At the National University of Rwanda (from right to left): Dr. David Cechetto, Rector Dr. Emile Rwamasirabo, Dean of Medicine Dr. Alexis Nyakayiro, and an NUR colleague

Dr. Rwamasirabo was aware that Western had a good medical school and asked if we could help rebuild the Rwandan medical sector. Our reaction was immediate and positive, but who could lead this on the Canadian side? I recalled that my friend Dr. David Cechetto had considerable personal experience in the health field in Africa and was also running a program at Western that sent medical students to Africa for field experience. I invited David to take the leadership role in responding to Rector Rwamasirabo’s request. He took a deep breath – I think David realized immediately that when he said yes, that decision would define the rest of his life – and said he wanted to gather more information, which he did. He travelled to Rwanda and then submitted a proposal to CIDA for funding. It was turned down, so he and I made another trip to Rwanda and submitted a second proposal, which was also turned down by CIDA.

So, we made yet another fact-finding trip to Rwanda, in which it became increasingly clear to us that Rwanda’s needs in the health field went well beyond the training of doctors. In fact, Rwandans we met emphasized the need for all front-line health workers, including nurses, midwives, and trauma therapists. We then submitted a third proposal in which the lead Rwanda institution was the Kigali Health Institute (led by Therese Bishagara) in cooperation with the National University of Rwanda. David engaged several colleagues at Western into the project and also initiated our collaborations with other Canadian universities. This third proposal was successful and David led, over the next six years in cooperation with our Rwandan partners, the Rebuilding Health in Rwanda project.

Two years ago, David submitted another successful proposal, this time for the Maternal, Newborn and Child Health project, which is now well under way. Other posts to this Forum will talk about the details of these two projects. Aided by these two projects and others like them, the determined efforts of the Rwandan people and government have created a resounding success story: various sources report that the infant and child mortality rate in Rwanda has plummeted by somewhere between 30% and 50% over the past ten years. Dr. Cechetto’s two projects have contributed and will contribute to progress in an area–maternal, newborn and child health–where Rwanda is attracting international attention. The reduction in Rwanda’s infant and child mortality rate (like that of Senegal) has been one of the real success stories in international development cooperation.

Let’s reflect on the success of these two projects – why have they worked so well? Here are some of the success factors:

* David Cechetto spent a lot of time in Rwanda listening carefully to the stakeholders in the health sector before he designed the project and before he chose his Rwandan and Canadian partners.
* Throughout the first project, Cechetto sought out the bilateral agencies of other donor countries to stimulate sector-wide complementarity in health care.
* At all levels of the health care system, Rwandans supported Cechetto and his teams with extraordinary commitment and enthusiasm.
* Over the years, Cechetto carefully managed the transition during the duration of the project from one initially led by Canadians to one of almost complete local ownership by the end of the project.

But above all, the participants in the projects had a sincere and long lasting commitment to improving the quality of life of all the people of Rwanda.

Dr. Frederick Keenan is the former Director of the Office of International Research at the University of Western Ontario, and is currently Co-chair (with former Archbishop Emmanuel Kolini) of the Project Advisory Council for the Maternal, Newborn and Child Health project in Rwanda.

On December 31, 2012, President Paul Kagame gave his annual State of the Nation Address to the Parliament of Rwanda. It had been 18 years since he led the Rwandese Popular Front to victory and put an end to the brutal genocide of 1994, and 12 years since he was first elected President in 2000. His short speech described some of the remarkable achievements of Rwanda, in such areas as living standards, health, and education. Near the end of speech, he urged the Parliament, Rwandans, and friends of Rwanda, to stay the course: “Rwanda is on the right path; what we need to do now is to stay focused on our vision, implement the plans we have made, and never get discouraged in the struggle to take our country and our people forward….” The full text of the speech can be found here.

I first met President Kagame in February of 2006 when I was President of Western University. I had come to Rwanda with our Vice-President (Research and International), Ted Hewitt, to see the work being done in the health area by Western faculty, led by Dr. David Cechetto of the Schulich School of Medicine & Dentistry. To our surprise, David, Ted, and I were invited to meet with the President in his offices at Urugwiro Village, the name given to the modest Presidential compound in Kigali. We were introduced to a man of remarkable focus, determination, and modesty.

He was well-informed on the work of David and his colleagues in health care education, training, and delivery, and led us in a fascinating conversation on the challenges facing health care in Rwanda and the options for moving forward. He questioned me about the possibilities of expanding Rwanda’s ties with Western. At the conclusion of the meeting he thanked us for Western’s commitment to Rwanda, and then asked me, “Is there anything I can do for you?”

It was not a question one expects from a Head of State. After recovering from my initial astonishment, I responded that I would be honored if he would come to Western and speak to our community about his plans for Rwanda. He answered with one word, “Yes,” and then nodded to his executive assistant seated near by.

Two months later, on April 24, 2006, President Kagame was at Western, where he gave a compelling speech on his vision for Rwanda, which followed in many respects the positions set out in an official government document, Vision 2020, released a few years earlier. The President spoke of a society founded on good governance, the rule of law, and respect for all its citizens; on economic growth led by the private sector and centered on the knowledge-based economy, science, and technology; on growing investments and performance in education and health care; on simultaneous progress on poverty reduction, infrastructure improvement, and growth in international trade and investment. The full text of Vision 2020 is here.

Members of the Rwanda diaspora in Canada and neighboring US states gathered at Western that day, and President Kagame addressed them in a separate speech. All told, it was one my most memorable days in fifteen years as President of Western.

Eight years later, in his 2012 State of the Nation address, the President could chart the tremendous progress made in reaching the goals of Vision 2020. Among the indicators referred to in his speech and in other recent articles on Rwanda are the following:

Economic growth continues to be strong. From 2000 to 2012, the average rate of growth of national income was 7.6%, so that over the last twelve years national income grew by a factor of 2.5. The President underline the strong progress in mining, tourism, and information and communications technology.

The poverty reduction priority of Vision 2020 has brought the fruits of economic growth to the entire population. From 2007 to 2012, the percentage of the population living in poverty was reduced from 56.9% to 44.9%.

Rwanda’s commitment to education has seen enrolments increase, in part because of a commitment to universal education for nine years. In his speech, the President note in particular the launch of the 12-Year Basic Education program, and the growth of enrolment in primary, secondary, and technical vocational education.

The most deadly infectious diseases are in retreat: the incidence of malaria has declined by 75% from 2000, and the incidence and death rates from HIV/AIDS and tuberculosis have also decline significantly.

Some 92% of Rwandans are covered by universal health insurance, which has contributed to dramatic reductions in infant and maternal mortality.

The government’s commitment to the rule of law has created a society where people feel safe and secure, a key contributor to social and economic progress. A Gallup Poll from November 2012 found that 92% of Rwandans felt safe in their communities, the highest such figure in Africa. By way of comparison, the figure for several African countries, including South Africa, was under 40%. A summary of the Gallup survey is here.

The rule of law has also helped make Rwanda a good place to do business for local and international firms. In the World Bank’s Doing Business report of June, 2012, Rwanda ranked 52 of 185 countries (i.e. in the top 30% in the world) in the overall ease of doing business; Rwanda ranked 3rd of 46 countries in Sub-Saharan Africa. Rwanda has been aggressive in removing obstacles to business. The same World Bank report listed 1,940 reforms in the countries surveyed between 2005 and 2012. Rwanda had 26 such reforms, the fourth largest total of any country in the world. The World Bank rankings are here.

Rwanda’s commitment to honesty in the public sector shows clearly in the 2012 Transparency International survey of corruption in government. Of 176 countries surveyed, Rwanda was ranked number 50 in least corrupt countries (i.e., in the top 30% in the world). Only two other African countries ranked in the top 50. The Transparency International report is here.

International recognition: Rwanda has received international recognition in all of the areas listed above. A good recent example in the health area is a recent article by Dr. Paul Farmer in the British Medical Journal (here).

The President concluded his State of the Nation address with a call to action that will inspire not only Rwandans, but Friends of Rwanda around the world:

“Let us show our resolve and commitment in this New Year, so that it may be even better than the year that just ended. May our economy grow and may we lift many more Rwandans out of poverty.”

Dr. Paul Davenport is the Chair of the Council of the Friends of Rwanda Forum and the Editor of the Forum’s website. He is President Emeritus of Western University and a Member of President Kagame’s President’s Advisory Council.